| NPI | 1861054298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE C WEIL Member 575-342-1236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103TH0004X Psychologist Health |
| Enumeration Date | 2019-07-06 |
| Last Update Date | 2023-03-25 |